Shakuta Saki, Noda Takumi, Kamiya Kentaro, Hamazaki Nobuaki, Nozaki Kohei, Yamashita Masashi, Uchida Shota, Ueno Kensuke, Maekawa Emi, Yamaoka-Tojo Minako, Matsunaga Atsuhiko, Ako Junya
Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan.
Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.
J Am Med Dir Assoc. 2024 Mar;25(3):514-520.e2. doi: 10.1016/j.jamda.2023.10.035. Epub 2024 Jan 3.
Sarcopenia in patients with heart failure (HF) is associated with poor prognosis. Cardiac rehabilitation (CR) decreases the incidence of adverse events in patients with HF. However, the clinical implications of improving sarcopenia status through CR remain unclear. This study investigated the relationship between the changes in sarcopenia status in patients with HF undergoing outpatient CR and the risk of mortality and adverse events.
This was a retrospective cohort study of patients hospitalized at the Kitasato University Hospital Cardiovascular Center for the treatment of HF between January 2007 and December 2020.
Patients with HF whose sarcopenia status was assessed at hospital discharge and following at least 3 months of outpatient CR were included. Based on the sarcopenia status, all patients were divided into 3 groups: patients without sarcopenia at discharge (ie, robust), patients with sarcopenia at discharge but no sarcopenia following CR (ie, improved), and patients with sarcopenia at discharge and following CR (ie, unimproved).
Cox regression analysis was used to examine the risk of all-cause death associated with the 3 sarcopenia status groups.
Of 546 patients with HF (median age: 70 years; male: 63.6%), 377 (69.0%), 54 (9.9%), and 115 (21.1%) were classified as robust, improved, and unimproved, respectively. Multivariate Cox regression analysis showed that the unimproved group had a significantly greater risk of all-cause death when compared to the robust group [hazard ratio (HR) 2.603, 95% CI 1.375-4.930, P = .004], but it did not differ from the improved group (HR 1.403, 95% CI 0.598-3.293, P = .43).
No improvement in sarcopenia status in patients with HF undergoing outpatient CR was associated with a higher risk of all-cause death. Sarcopenia may be an important target to improve the prognosis of patients with HF.
心力衰竭（HF）患者的肌肉减少症与预后不良相关。心脏康复（CR）可降低HF患者不良事件的发生率。然而，通过CR改善肌肉减少症状态的临床意义仍不明确。本研究调查了接受门诊CR的HF患者肌肉减少症状态的变化与死亡风险及不良事件之间的关系。
这是一项对2007年1月至2020年12月期间在北里大学医院心血管中心住院治疗HF的患者进行的回顾性队列研究。
纳入在出院时及至少3个月门诊CR后评估了肌肉减少症状态的HF患者。根据肌肉减少症状态，将所有患者分为3组：出院时无肌肉减少症的患者（即强壮组）、出院时有肌肉减少症但CR后无肌肉减少症的患者（即改善组）、出院时及CR后均有肌肉减少症的患者（即未改善组）。
采用Cox回归分析来检验与这3种肌肉减少症状态组相关的全因死亡风险。
546例HF患者（中位年龄：70岁；男性：63.6%）中，分别有377例（69.0%）、54例（9.9%）和115例（21.1%）被分类为强壮组、改善组和未改善组。多变量Cox回归分析显示，与强壮组相比，未改善组全因死亡风险显著更高[风险比（HR）2.603，95%置信区间1.375 - 4.930，P = 0.004]，但与改善组无差异（HR 1.403，95%置信区间0.598 - 3.293，P = 0.43）。
接受门诊CR的HF患者肌肉减少症状态未改善与全因死亡风险较高相关。肌肉减少症可能是改善HF患者预后的一个重要靶点。
